Deviation in the Standard of Podiatric Care During Bunion Surgery

Evaluate breaches in the standard of care by asking and answering the questions herein below and analyzing as well to determine if there has been a Deviation in the Standard of Podiatric Care During Bunion Surgery

Answer the following questions to find out if the standard of care was followed for your case.

With which of the following symptoms did the patient present? (Choose all that apply)Plantar foot painOutward turned first toe that may overlap the second toeThickened skin over the bony protrusion at the base of the first toe (callus)SwellingSymptoms not elicitedAnswer unknownWhy is this important?Symptoms of hallux valgus include poor-fitting shoes, plantar foot pain, medial first Metatarsophalangeal (MTP) joint pain, deep MTP aching pain from joint degeneration, and pain with weight bearing.(2014) 98 EMEDCN 2 227-232

With which of the following risk factors of bunion did the patient present? (Choose all that apply) Why is this important?Answer this question The cause of hallux valgus (bunion) associated with genetic predisposition, restrictive footwear, other foot deformities such as pronation of the hindfoot and pesplanus (flatfoot),hypermobility, contracture of the Achilles tendon, and neuromuscular disorders such as cerebral palsy and stroke. (2014) 98 EMEDCN 2 227-232

Was a medical history obtained and documented? Why is this important?Answer this question Past Medical History (PMH) includes all past and current illness, hospitalizations, surgery, trauma, allergies, and medications. The date, location, and physician/surgeon for each hospitalization and/or surgery should also be included. Particularly important issues in the identification of manifestations of systemic disease include alcoholism, cancer, cardiovascular events, diabetes, and hepatic, renal, and psychiatric reasons for admission. Particularly important medications for oral manifestations include immunosuppressives, antibiotics, cardiac medications, and psychotropics. The PMH is also important for investigating whether the Chief Complaint (CC) is a manifestation of a previously diagnosed disorder. (2011) 55 EDECNA 1 15-28

Was a physical examination performed? Why is this important?Answer this question A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions that must be addressed at various points throughout the patient's lifetime. Click here for additional information

Was an x-ray of the affected foot obtained? Why is this important?Answer this question Radiographs of the foot need to be taken with the patient in the weight-bearing position. The basic studies should include AP, lateral, and oblique views. Click here for additional information

Was the patient diagnosed with a bunion deformity? Why is this important?Answer this question Hallux valgus (bunion) is readily apparent with clinical inspection of the patient. Significant findings may include a subcutaneous bony prominence or medial bump. (2003) 42 JFAASU 3 112-123

With what severity of bunion deformity was the patient diagnosed? Why is this important?Answer this question The severity of a bunion deformity is typically based on symptoms and radiologic assessment using weight-bearing radiographs and is described as mild, moderate, or severe. No one classification is perfect, and the numbers used to define a mild, moderate, or severe deformity are not “etched in stone”. Classification should be used only as a general guide. (2014) 98 EMEDCN 2 227-232

Was a vascular evaluation of the affected foot performed? Why is this important?Answer this question Vascular evaluation includes palpation of the dorsalis pedis and posterior tibial pulses, observation of capillary filling of the toes, and assessment of the skin and hair pattern. If there is any question regarding the circulatory status of the foot, a Doppler evaluation is obtained. Click here for additional information

Was a neurologic examination of the affected foot performed? Why is this important?Answer this question The neurologic examination focuses on sensation, vibratory sense, and strength of the intrinsic and extrinsic muscles. Often, a sensory deficit may develop with reduced sensation over the medial eminence and medial hallux. Click here for additional information

Which of the following conservative treatment options were recommended? (Choose all that apply) Why is this important?Answer this question Conservative care in most patients with a bunion deformity is adequate to relieve symptoms. A symptomatic mild hallux valgus deformity should be periodically examined and radiographs obtained to evaluate any progression in the magnitude of the deformity. Click here for additional information

With which of the following indications for bunion surgery did the patient present? (Choose all that apply) Why is this important?Answer this question Although cosmesis is mentioned as a possible indication for surgery, pain and discomfort should be the major considerations for surgical correction. It may be difficult on occasion to distinguish between a patient's concern for cosmesis and actual discomfort. Click here for additional information

Was bunion surgery recommended? Why is this important?Answer this question With more than 100 surgical procedures described in the literature to correct a hallux valgus deformity, no procedure is adequate to correct all bunion deformities. An algorithm has been developed that gives the clinician a logical scheme with which to approach a patient with a hallux valgus deformity. The deformity is placed into one of three main groups according to the radiographic appearance: a congruent joint, an incongruent (subluxated) joint, or a joint with arthrosis. Click here for additional information

With which of the following contraindications for surgical intervention did the patient present? (Choose all that apply) Why is this important?Answer this question Non-surgical care should also be considered in patients with hyperelasticity, ligamentous laxity, or neuromuscular disorders because of the high recurrence rate. Click here for additional information

Was an informed consent obtained? Why is this important?Answer this question The laws of most states require that surgeons obtain informed consent before providing treatment. (2011) 23 EOMSCA 3 475-484

Which of the following surgical treatment options were recommended? Why is this important?Answer this question Not all hallux valgus deformities are equal, and many different factors must be considered when evaluating a deformity for surgical intervention. Click here for additional information

Was a pre-operative evaluation performed? Why is this important?Answer this question A pre-operative basic health assessment is typically performed within 30 days of planned surgery. At least a limited assessment is mandated by the Joint Commission on Accreditation of Healthcare Organizations on all patients, but a more thorough evaluation is necessary to obtain a comprehensive view of patient risk factors. Click here for additional information

Were prophylactic antibiotics administered prior to the surgery? Why is this important?Answer this question Use of pre-operative and peri-operative prophylactic antibiotics is a key to reducing systemic infections. (2012) 26 EIDCNA 1 29-39

Was the affected toe positioned accurately during the surgery? Why is this important?Answer this question Accurate positioning of the hallux is essential during the procedure of bunion surgery. Click here for additional information